الفهرس 
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Abstract
Diabetes mellitus is a heterogeneous group of disorders due to an absolute or relative shortfall in insulin synthesis or action, hyperglycemia results. The chronic hyperglycemia of diabetes mellitus is associated with end organ damage, dysfunction, and failure, including the retina, kidney, nervous system, heart, and blood vessels. The International Diabetes Federation (IDF) estimated an overall prevalence of diabetes mellitus to be 366 million in 2011, and predicted a rise to 552 million by 2030.
Diabetes mellitus is a well recognized risk factor for cardiovascular disease and diabetic individuals with acute coronary syndrome (ACS) have a two- to four fold increased risk of adverse cardiovascular events compared to non-diabetic individuals.
Prediabetes a dangerous medical condition where blood sugar levels are elevated but not yet high enough to be diagnosed as type 2 diabetes .A person with prediabetes is at high risk of type 2 diabetes, heart disease, and stroke. It is becoming more and more obvious that poor glucose tolerance and the pre-diabetic condition also contribute to unfavourable clinical outcomes.
The aim of our study was to determine the relation of diabetes and, prediabetes with acute coronary syndrome and outcome among patients who were admitted to CCU of Sohag University Hospital.
This was a prospective observational study, was carried out at Sohag University Hospital during the period from 1/6/2021 to 1/12/2021. All patients included in the study were subjected to: Full history taking, 2-Detailed clinical examination, Laboratory investigations, and Daily follow up chest pain, ECG, blood pressure, fasting blood sugar, any sign of heart failure, or any complication occur.
Our results showed that:
the mean age of the studied cases was 57.62±9.65, 37% were females, 63% were males, 27% were pre-diabetics, 100% had uncontrolled diabetes, 37% were hypertensive, 29% were current smoker, mean of BMI was 30.85±3.43 and 14% had Previous PCI or CABG
-there was significant difference between all studied groups as regards Hypertension, BMI and previous PCI (p< 0.05).
Also, there was there was significant difference between pre-diabetic and known diabetic as regards sex, Hypertension, BMI and smoking (p< 0.05).
Additionally, there was significant difference between First discovered DM and known diabetic as regards Hypertension and previous PCI (p< 0.05).
-there was insignificant difference between all studied groups as regards clinical presentations (p > 0.05).
- there was insignificant difference between all studied groups as regards chest pain and ECG (p > 0.05)
-We found that ACS patients in this study. The prognosis for patients with prediabetes was worse than for those with normoglycemia, although the results were comparable for those with prediabetes and DM.
Conclusion
ACS Patients with pre-diabetes had a poorer prognosis compared to those with normoglycemia, while the outcomes were similar among patients with pre-diabetes and diabetes These data support the idea that prediabetes is a risk factor of CV disease. In clinical practice, assessment of HbA1c may help to identify prediabetes and further stratify high-risk patients presenting with MINOCA.
Recommendation
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
Strict monitoring of serum glucose levels at admission for all patients presented with ACS, diabetic and non-diabetic patients are required, and tight management of hyperglycemia is mandatory.
Routine screening for undiagnosed diabetes may be useful since these patients seem to have worse short-term outcomes and deserve consideration of alternative management strategies.
New therapeutic approaches are needed to improve long-term prognosis in these patients.